d zwe yan naing mmedsc og studentIUC.pptx

for og

1. Intrauterine contraception FSRH Guideline March 2023

2. Contents Purpose and scope Identification Introduction Summary of changes What is IUC Effect Assess suitability Health risk 9. Side effect 10. Insertion 11. Emergency management for problem 12. Documentation 13. Aftercare 14. Problem associated with IUC 15. Safe removal

3. PURPOSE AND SCOPE Update the previous Faculty of sexual & Reproductive health and intended for use of IUC by healthcare practitioners

4. Introduction IUC --highly effective, reversible 159 million users worldwide Two categories in UK Cu- IUD, LNG-IUD

5. LNG-IUD ` IUC Cu-IUD Copper T380 T safe380 Multiload 375 Nova380 Ag Mirena jaydess levosert Cu-IUD Overall failure rate- 0.6-0.8 in first year of use Can be used 5-10 yrs >40 YRS, can be until menopause Highly effective in EC LNG-IUD 13.5 mg -3yr 19.5 mg – 5 yr 52.5 mg – 6yr Use for 5 yr of endometrial protection in HRT patient ( oestrogen ) Risk of ovarian cyst Previous ectopic pregnancy in not a contraindicaiton

6. Cu-IUD -non hormonal vary in size and shape -contain copper and plastic ,barium for radioopaque - insert within 5 days after first episode of upsi or withhin 5 days of earliest expected date of ovulation -effective immediate after insertion - prefertilization effect ->300mm2 >40 yr can be used until menopause -

7. LNG-IUD - T shaped with elastomere core containing progestogen levonogestrel . -effective 7 days after insertion - prefertilization effect -52mg LNG IUD release 20mcg per day, potential benefit in HMB and dysmenorrhea -inserted >45 yr until 55yr for contraception -used 5 yr for endometrial protection as part of HRT -19.5 LNG IUD release 17.5 mcg per day 3.5 LNG IUD release 14mcg per day

8. UKMEC Definition of UKMEC category . Category 1 A condition for which there is no restriction for the use of the method Category 2 A condition where the advantages of using the method generally outweigh the theoretical or proven risks. Category 3 A condition where the theoretical or proven risks usually outweigh the advantages of using the method. The provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable. Category 4 A condition which represents an unacceptable health risk if the method is used.

9. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)2 categories for the use of intrauterine contraception for age and parity Condition Age (years) UKMEC category for Cu-IUD UKMEC category for LNG-IUD Parity Menarche to <20 = 2 ≥20 = 1 Menarche to <20 = 2 ≥20 = 1 a) Nulliparous 1 1 b) Parous 1 1

10. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)2 categories for the use of intrauterine contraception for postpartum and post-abortion Condition UKMEC category for Cu-IUD Condition UKMEC category for Cu-IUD UKMEC category for LNG-IUD Postpartum a) 0 to <48 hours 1 1 b) 48 hours to <4 weeks 3 3 c) ≥4 weeks 1 1 d) Postpartum sepsis 4 4 Post-abortion a) First trimester 1 1 b) Second trimester 2 2 c) Post-abortion sepsis 4 4

11. gestational trophoblastic disease Condition UKMEC category for Cu-IUD UKMEC category for LNG-ID a) Undetectable hCG levels 1 1 b) Decreasing hCG levels 3 3 c) Persistently elevated hCG levels or malignant disease 4 4

12. contraception after breast cancer Condition UKMEC category for Cu-IUD UKMEC category for LNG-IUD a) Current breast cancer 1 4 b) Past breast cancer 1 3

13. individuals with anatomical abnormalities of the uterine cavity Condition UKMEC category for Cu-IUD UKMEC category for LNG-IUD a) Distorted uterine cavity 3 3 b) Other abnormalities 2 2

14. individuals with uterine fibroids Condition UKMEC category for Cu-IUD UKMEC category for LNG-IUD a) Without distortion of the uterine cavity 1 1 b) With distortion of the uterine cavity 3 3

15. individuals at risk of infection Condition UKMEC category for Cu-IUD UKMEC category for LNG-IUD Past PID (assuming no current risk factor for STIs) 1 1 Current PID I C I C 4 2 4 2 Sexually transmitted infections (STIs) Chlamydia infection (current) I C I C 4 2 4 2 Purulent cervicitis or gonorrhoea (current) I C I C 4 2 4 2 Other current STIs (excluding HIV and hepatitis) 2 2 Vaginitis (including Trichomonas vaginalis and bacterial vaginosis) (current) 2 2

16. Side effects associated with IUC use

17. IUC insertion Discussion When can IUC be inserted? Insertion checklist How can safe insertion of IUC be facilitated? Practical aspects of IUC insertion Pain associated with IUC insertion Post-procedure analgesia

18. THANK YOU